Chronic headaches are one of the most under-treated problems we see. Most patients arrive having been told to take something over the counter and manage stress, with no one having ever examined the neck, the jaw, their sleep, or their hormones.
Headaches are not all the same
Getting this right starts with identifying which type you actually have:
- Cervicogenic headache: pain referred from the joints and muscles of the upper neck. Often one-sided, often worse after a day at a desk, and frequently misdiagnosed as migraine.
- Tension-type headache: a band-like pressure driven by sustained muscular load in the neck, jaw and shoulders.
- Migraine: a neurological event, often with light and sound sensitivity, nausea, and sometimes visual aura.
- Mixed presentations: extremely common, and the reason single-modality treatment so often fails.
What we look for
- Cervical spine mechanics: restricted upper cervical joints refer pain into the head in very predictable patterns
- Jaw and bite: clenching loads the temporalis and masseter and drives daily headache
- Postural and workstation load: the single most common modifiable factor we find
- Sleep quality and sleep apnea risk: untreated apnea is a frequent cause of morning headache
- Hormonal and metabolic factors: low testosterone, blood sugar swings and dehydration all contribute
- Medication overuse: daily analgesics can themselves sustain a headache cycle
How we treat it
Depending on what the assessment finds, treatment may include manual therapy and mobilization of the cervical spine, targeted soft-tissue work, trigger point injections, therapeutic Botox® for chronic migraine in appropriate cases, postural rehabilitation, IV hydration and nutrient therapy for specific patterns, and correcting the metabolic or hormonal factors sitting underneath.
When a headache needs urgent evaluation
Seek emergency care for a sudden "worst headache of my life," a headache with fever and a stiff neck, a headache following a head injury, or one accompanied by weakness, confusion or vision loss. Those need imaging, not an appointment next week.